| NPI | 1912548843 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-21-56107) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: TX BACB528513) |
| Enumeration Date | 2019-10-02 |
| Last Update Date | 2021-12-20 |